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Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Summary:

+ Facilitates and coordinates the discharge plans for patients requiring complex in-depth care coordination to achieve a safe discharge plan. These plans will require the coordination of internal resources, communication with interdisciplinary care team, coordination of home care, DME, placements, hospice, community resources, transportation, active involvement of multiple community, state and federal programs, internal legal department consultation, international consulates and facilities. This individual will serve as an expert consultant to the Case Managers, Social Workers and other departments within the Penn Presby Medical Center to advise and assist with challenging and complex care coordination. The person will provide expertise regarding the management of the behavioral health patient and the certification process involved. Fostering relationships with state and governmental agencies in addition to insurance providers is critical to support the mission of PPMC.

Responsibilities:

+ Serves as an expert resource to the Nurse Case Managers and Medical Social Workers to provide guidance in coordinating complex discharges and optimize insurance benefits.

+ Discharge planning activities: coordination of home care, DME, placements, hospice, community resources, transportation.

+ May conduct psychosocial assessments and provides psychosocial support/counseling to patients and families in the health care setting.

+ The Complex Care Discharge Specialist will offer ongoing education to the CM/SW staff on the availability of services in the community.

+ The Complex Care Discharge Specialist will foster collaboration with the health care team as well as Case Management, Social Work, and Medical Team colleagues in other care settings.

+ Serves as the liaison between the hospital and transport companies (ie ambulance, wheelchair van, air transport, helicopter, etc).

+ Completes timely and detailed assessment of a select population of patients and family social, emotional and/or discharge needs and health care benefits.

+ Develops and facilitates specific plan to address problems and/or concerns identified by patients, families and health care team for a select group of patients.

+ Coordinates repatriation cases to meet all of the state regulatory requirements and documentation. Works with repatriation company, family, embassy/consulate and foreign government and health care facilities to ensure a safe and legal repatriation of the patient to their home country.

+ Works with department leadership to develop and implement creative solutions to issues and care barriers identified by the Medical Team and the Case Management/Social Work Team.

+ Organizes interdisciplinary meetings as needed to assist with creating and implementing a safe Discharge plan.

Credentials:

+ Registered Nurse - PA (Required) or Licensed MSW (Required)

Education or Equivalent Experience:

+ RN requires an MSN (Required)

+ Social Worker requires an MSW (Required)

+ Education Specialization:Master’s degree in Social Work from A CSWE accredited programEquivalent Experience:•And 10+ years Recent Social Work experience in a health care setting

+ MSN requires 10+ years recent hospital case management experience

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

REQNUMBER: 268720